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- Sixteen patients, 10 boys and 6 girls with severe urinary incontinence due to congenital malformations, were treated by free autogenous muscle transplantation. The mean follow-up period was 2.3 years. In 10 patients the results were good, implying increase in functional bladder capacity and abandoning of napkins during the day. Two patients were improved and 4 were failures. The earliest signs of improvement appeared 2 to 6 months after surgery. Most patients showed further improvement for at least 2 years post-operatively. Cine studies of micturition clearly showed activity of the transplant, most patients with good results being able to interrupt completely the urinary stream at will. Seven patients exhibited normal urinary flow post-operatively. In 5 patients the maximal urinary flow was around the lower normal limit, in two because of detrusor-sphincter dyssynergia. In boys, erection was unimpaired post-operatively. The prognosis seems to be better in girls than in boys, especially when comparing cases of epispadias. Patients with no sign of improvement during the first 6 months post-operatively had a poor prognosis. A relatively large bladder capacity before operation is advantageous, but not a prerequisite for continence, as bladder capacity can develop after transplantation. The ideal age for transplantation is 5 to 6 years. [ABSTRACT FROM AUTHOR]

A retrospective cohort study was performed in Sweden to evaluate the possibility that an individual symptom or constellation of illness symptoms related to silicone occurs in women after breast implant surgery. A random sample (n = 2500) of all women in the Swedish national implant registry who underwent breast augmentation surgery with alloplastic breast implants during the years 1965 through 1993 was compared with a sample (n = 3500) of women who underwent breast reduction surgery during the same period, frequency matched to the implant patients for age and calendar year at the time of surgery. In total, 65 percent of the breast implant patients (n = 1546) and 72 percent of the breast reduction patients (n = 2496) completed a self-administered questionnaire covering 28 rheumatologic and other symptoms and lifestyle and demographic factors. Practically all of the 28 symptoms inquired about were reported more often by women in the breast implant cohort, with 16 (57 percent) significantly more common in breast implant recipients. In contrast, few significant differences or consistent patterns were observed in the length of time since the implant and in the type (silicone or saline) or volume of the implant. Although women with breast implants report a multitude of symptoms more often than women who have breast reduction surgery, the lack of specificity and absence of dose-response relationships suggest that the excess of reported symptoms is not causally related to cosmetic implants.

Epidemiologic studies have found no association between breast implants and cancer or well-defined connective tissue diseases. However, women with cosmetic breast implants continue to report specific as well as nonspecific physical and psychological symptoms after receiving their implants. In an attempt to determine whether local complications of implantation may contribute to this excess of symptom reporting, the authors studied a large cohort of women in Sweden with cosmetic breast implants (n = 1280) and a comparison cohort of women who had cosmetic breast reduction surgery (n = 2211). Both groups of women had operations between 1969 and 1996. Medical record reviews of local complications revealed that approximately 31 percent of the women with cosmetic breast implants had an implant change, implant leakage, or a capsulotomy. Capsulotomies occurred more often in women who were age 35 or older at the time of the operation, had ever smoked, and had implants with a smooth surface. On self-administered questionnaires, symptoms were reported more often by the women who had implants regardless of whether they had local complications. Twenty of the 28 symptoms occurred more frequently among women with local complications and breast implants, compared with the women in the breast reduction comparison group or the women with breast implants but no local complications. This study suggests that local complications, particularly capsular contractures as indicated by capsulotomy, may be an important factor to consider when studying symptom reporting among women with breast implants.

To determine whether women with cosmetic breast implants have distinct demographic, lifestyle, and reproductive characteristics that put them at increased risk for subsequent morbidity, the authors compared 1,369 such women to 2,211 women who had undergone breast reduction surgery, and to a random sample of 49,262 women from the general population of Sweden. Information was collected through self-administered questionnaires, and comparisons were made using the prevalence odds ratio. Women with cosmetic breast implants were significantly (p <0.05) more likely to be current smokers, have a lower body mass index, have had a prematurely terminated pregnancy (induced abortion or miscarriage), and have had fewer live births than either women who underwent breast reduction or women from the general population. Type of implant (silicone gel or saline) did not modify the associations. Regardless of the comparison group used, studies of the health effects of breast implants need to consider that women who undergo cosmetic breast implantation have certain distinct characteristics.

The aim of this prospective, controlled clinical investigation was to compare the capsular contracture rate between silicone implants with a smooth and those with a textured surface. The implants were otherwise identical. Twenty-five women with bilateral mammary hypoplasia underwent augmentation mammoplasty. All received a textured implant on one side and a smooth implant on the other. Before surgery the patients were told that they could have the implants changed if the study showed that one type was better than the other. The investigation was conducted with the double-blind technique, with the code broken 1 year after surgery. At 1-year follow-up (reported previously) three parameters were used to estimate the tendency to capsular contracture: (1) the patient's opinion on differences in hardness of the breasts, (2) the investigators' classification of capsular contracture, and (3) applanation tonometry. All parameters showed unequivocally that the breasts augmented with textured implants had a lower tendency to develop capsular contracture than those with smooth implants. Five years after surgery 17 patients had had their smooth implant changed to a textured one because of hardness. Only one of the textured implants had been removed. A comparison between the 1-year and 5-year tonometric results of the 24 breasts that still had the original textured implants showed that after 5 years, a small but statistically significant increase in hardness had occurred compared with that after 1 year.

The aim of this prospective, controlled clinical investigation was to find out if there is a difference in the capsular contracture rate between silicone implants with a smooth or textured surface as the only difference. Twenty-five women with bilateral mammary hypoplasia underwent mammary augmentation. All got a textured implant on one side and a smooth implant on the other. The implants were placed subglandularly. Follow-up examinations were done on six occasions. Three parameters were used for estimation of the tendency to capsular contracture: (1) the patient's opinion on differences in hardness of the breasts, (2) the investigator's classification of capsular contracture, and (3) applanation tonometry. At the end of the follow-up period, after 1 year, all parameters showed with no doubt that the breasts augmented with textured implants had a lower tendency to develop contracting capsules than the breasts augmented with smooth implants.

A 16-year-old girl presented with a large and rapidly growing cystosarcoma phyllodes in her right breast. The excised tumour showed unequivocal malignant characteristics at light and electron microscopy and was oestrogen-receptor negative. After repeated early local recurrences, a subcutaneous mastectomy ultimately led to local tumour control and the patient is now disease free 5.5 years after diagnosis.

Free autogenous muscle transplantation has now been carried out in 13 patients with anal incontinence and 16 patients with urinary incontinence. In anal incontinence the results have been excellent; all patients were improved and 12 out of 13 reached an acceptable level of continence. In 10 patients with urinary incontinence the results were good, with increase of functional bladder capacity and abandonment of nappies during the day. Two patients were improved and 4 were failures. Cinematographic studies in both anal and urinary incontinence clearly demonstrated the muscular activity of the transplants and confirmed the existence of a reinnervation process. The longest postoperative observation time is now 7-years in the anal patients and 6 years in the urinary patients.

Physiological properties (tetanic tension, single twitch, fatigability) of free autologous muscle transplants in cats were examined in vivo five months after transplantation. After 2 weeks denervation the peroneus longus muscle was placed isometrically in the abdomen with the omentum around the muscle and with the proximal end of a cut branch of the femoral nerve attached to the muscle. (In one case a sensory nerve was used.) Five months after transplantation the function of the muscle was controlled in vivo by nerve stimulation. In the case when a sensory nerve was connected to the muscle no contraction was obtained upon indirect or direct stimulation. All the other muscles contracted when the nerve was stimulated. The mean maximum tetanic tension was 16% of the mean for the control. The twitch-time was about the same as in the control muscle but the contraction time was longer and the half relaxation time shorter compared with the control. The transplanted muscles fatigued more slowly than the normal peroneus longus muscles. In spite of the unphysiological placement of the muscles in the abdomen where they have no natural function to fulfil, they became reinnervated and contracted as late as five months after transplantation.

Free autologous transplants of previously denervated whole muscles in adult cats were studied with histochemical and electromyographical methods. The transplants were placed in contact with normal intercostal muscles in intercostal spaces and removed at intervals from 5 days to 44 weeks after transplantation. Normal muscles as well as transplanted muscles without previous denervation and muscles denervated and left in situ were also studied.. The fibres of the previously denervated grafts survived the first avascular period, but a de-differentiation of enzymatic characteristics of the red and white fibres occurred and endured during the first 6 weeks after grafting. The first signs of reinnervation could be identified with electromyography after 4 weeks and with histochemical techniques after 6. Reinnervation of most of the fibres of the transplants was completed about 14-18 weeks after grafting. No fibrillations were then found electromyographically and in the histochemical preparations most fibres had attained near-normal staining characteristics. Type grouping was apparent but less pronounced than reported after reinnervation through the motor nerve. There was conclusive evidence that previously denervated muscles survived transplantation and became structurally and enzymatically mature whereas muscles transplanted without previous denervation undergo extensive fibrotic changes.

After 2 weeks of denervation, whole leg muscles of adult cats were transplanted to intercostal spaces and removed at intervals from 5 days to 44 weeks after grafting. The connective tissue formation and capillary supply of the grafts were studied histologically and histochemically for connective tissue and ATPase. In addition, normal muscles, denervated muscles left in situ, and muscles transplanted without previous denervation were studied. During the denervation period of 2 weeks the capillary network increased slightly. During the first 6 weeks after grafting only a few, thick-walled, irregularly shaped capillaries were present in the grafts. At 8-12 weeks there was a pronounced increase in the vascular supply, coincident with reinnervation of the grafts, and after 40 weeks the capillary pattern appeared fairly normal. In the early stages a marked increase in perimysial and endomysial connective tissue took place. With increasing reinnervation a gradual disappearance of the endomysial connective tissue occurred and in the most mature grafts a minimal increase of perimysial connective tissue remained. In muscles transplanted without previous denervation, extensive fibrotic changes developed.

Five children with urinary incontinence were operated with a new method involving free autogenous muscle transplantation. Before transplantation a skeletal muscle (extensor brevis of the foot) is denervated and, 2 weeks later, it is transplanted and placed as a U-sling around the urethra in close contact with normally innervated muscles, which act as reinnervation sources. All patients showed improvement of continence and increasing bladder capacity from about 2 months after transplantation. Postoperative cine-micturition studies clearly demonstrated the functional properties of the transplanted muscle and estimation of urinary flow rate showed no signs of infravesical obstruction.

The derivation of histiocyte-like cells in malignant fibrous histiocytoma (MFH) has been a matter of debate. To shed light on this problem two cell lines from two subsequent recurrencies of MFH were established. The existence of two different cell populations, mainly fibroblast-like in the first cell line and mainly histiocyte-like in the second, was shown by light and electron microscopy, DNA measurements, and karyotype analysis. By detailed banding analysis and identification of several identical chromosomal marker types in the two cell lines, it was proven that they originally derived from the same single cell or single clone. Because the first cell line, with mainly fibroblast-like cells, was in the hypotriploid region and the second, with mainly histiocyte-like cells, was in the penta-hexaploid region, the data explained the appearance of histiocyte-like cells in MFH as a consequence of chromosomal progression.

End-plate formation in free autologous transplants of previously denervated whole muscles in adult cats were studied with a histochemical technique for cholinesterase. Grafts from 5 to 40 weeks old have been examined. The original end-plates degenerated and could not be seen in transplants older than 9 weeks. New, immature end-plates formed at many sites in the transplants. They were seen as early as 5 weeks after transplantation. They progressively increased in number during the first 12 weeks. In the oldest transplants the end-plates were relatively mature and appeared in clusters or were scattered.

Urinary incontinence owing to epispadias or bladder exstrophy is a difficult therapeutic problem. To improve the results a new method, including free autogenous muscle transplantation, was developed. Before transplantation a skeletal muscle (extensor brevis of the foot) is denervated and, 2 weeks later, it is transplanted and placed as a U-sling around the urethra in close contact with normally innervated muscles, which act as reinnervation sources. Two patients showed improvement of continence and increasing bladder capacity from 6 weeks after transplantation. Postoperative cine-studies of micturition demonstrated clearly the functional properties of the transplanted muscle.

For reanimation of the cheek in 8 young patients with long-standing facial palsy a method with cross-face nerve grafting followed by free muscle transplantation has been used. The sural nerve was used as nerve graft and placed in a subcutaneous tunnel across the face. In the normal cheek 3-4 fascicles of the nerve were anastomosed to facial nerve branches innervating muscles elevating the angle of the mouth. Four to 13 months later the extensor digitorum brevis muscle to the second toe or the palmaris longus was transplanted to the paralysed cheek. It was attached between the zygomatic arch and the angle of the mouth. The end of the nerve was sutured to the muscle after taking a biopsy. The follow-up period has been 7-30 months. At 7 months 6 patients had positive EMG, either on voluntary movement or on stimulation of the contralateral facial nerve. Three of them had also a slight movement in the cheek. Two patients are as yet only 7 months postoperative. In the remaining two cases, No. 2 and 4, there were no signs of reinnervation. At 18 months 4 out of 6 patients had a synchronous natural contraction in the cheek giving increased balance to the mouth. These patients had a positive EMG. In patients No. 2 and 4 there was neither innervation nor improvement. At 30 months there was additional improvement in two cases but as previously in patients No. 2 and 4 there was neither improvement nor signs of innervation of the muscle on the EMG. The other 4 patients have not reached this postoperative stage.(ABSTRACT TRUNCATED AT 250 WORDS)